CAJ | 학술논문

目的总结二尖瓣人工腱索移植术的手术治疗经验.方法选择应用二尖瓣人工腱索移植术治疗的退行性二尖瓣脱垂并关闭不全患者105例.其中,单纯人工腱索移植25例,人工腱索移植+后叶楔形切除67例,人工腱索移植+后叶楔形切除+Sliding 13例.结果术后早期无死亡病例.术后并发症:窦性心动过缓8例、室上性心动过速20例、延迟性心包填塞1例、术前心房颤动伴快-慢综合征患者永久起搏器置入l例,均治愈出院.住院时间9～21 (14±4)d.术后随访96例,随访率91.4％(96/105).随访3个月至5年.96例随访患者中,l例术后13个月死于脑梗死,1例死于交通事故,余94例均存活.NYHA心功能分级Ⅰ级74例,Ⅱ级20例.复查心脏彩超示微量及以下反流92例,轻度反流2例,未发现人工腱索断裂或劈裂.结论严格选择病例,掌握恰当的手术技巧,同时做好术中成形效果的评估和体外循环期间的心肌保护,是提高二尖瓣人工腱索移植术疗效的关键.
목적 총결이첨판인공건색이식술적수술치료경험.방법 선택응용이첨판인공건색이식술치료적퇴행성이첨판탈수병관폐불전환자105례.기중,단순인공건색이식25례,인공건색이식+후협설형절제67례,인공건색이식+후협설형절제+Sliding 13례.결과 술후조기무사망병례.술후병발증:두성심동과완8례、실상성심동과속20례、연지성심포전새1례、술전심방전동반쾌-만종합정환자영구기박기치입l례,균치유출원.주원시간9～21 (14±4)d.술후수방96례,수방솔91.4％(96/105).수방3개월지5년.96례수방환자중,l례술후13개월사우뇌경사,1례사우교통사고,여94례균존활.NYHA심공능분급Ⅰ급74례,Ⅱ급20례.복사심장채초시미량급이하반류92례,경도반류2례,미발현인공건색단렬혹벽렬.결론 엄격선택병례,장악흡당적수술기교,동시주호술중성형효과적평고화체외순배기간적심기보호,시제고이첨판인공건색이식술료효적관건.
Objective To summarize the experience of application of artificial chordae transplantation in mitral valve repair.Methods One hundred and five patients with mitral regurgitation due to mitral degeneration,underwent mitral valve repair with artificial chordae transplantation.Operative technique included simple Gore-Tex artificial chordae transplantation in 25 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 67 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet and Sliding technique in 13 cases.Results No early death occurred after operation.The postoperative complications were caused in 30 patients including sinus bradycardia in 8 cases,supraventricular tachycardia in 20 cases,late cardiac tamponade in onecase,pacemarker implantation in one case.Hospital time was 9-21 (14 ±4) d.Follow-up was done to 96 patients for 3 months to 5 years with a follow-up rate of 91.4％(96/105).Among 96 cases,one died of cerebral infarction after 13 months,one died from accident while the remaining were alive,74 cases were with cardiac function (NYHA) of grade Ⅰ and 20 cases with grade Ⅱ.No regurgitation was found in 92 cases,mild regurgitation in 2 cases.There were no artificial chordae ruptures.Conclusions The key to improve the early and midterm results of artificial chordae transplantation are to choose patients strictly,to grasp proper surgical skills,to do a good job in intraoperative shaping effect evaluation and the myocardial protection during extracorporeal circulation.